Choosing Death 

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In early September 2011, Dominic Dawson, a lean and soft-spoken delivery driver who lives in Manila, received an email from his ailing father in Wales. "I'm ready to go to Switzerland, October 2012," Reg Dawson wrote his son. "What do you think?" Dominic was sitting at his desk in a second-story cupola peering over Humboldt Bay. From here, he could often see small flocks of dowitchers erupting from the shore, shimmering in the morning haze. He knew that "Switzerland" meant his father hoped to die at a Zurich apartment where an organization called Dignitas helps people commit suicide legally. Diffuse sunlight seeped through the old Victorian's window. Outside, shore birds pecked in the mud, shifting and turning in unison. Dominic cradled his coffee mug.

He was surprised, but not shocked. His father, in his late 80s and struggling with Parkinson's disease. was losing the ability to walk unassisted, sit upright and feed himself. About a year before, Reg had begun talking about Dignitas with his wife and his daughter, Teresa Schwanauer. When Teresa filled Dominic in, she'd confided that she didn't think their father would go through with it. Now Reg was sounding more certain. And Dominic felt oddly comforted that his father had reached out to him, after a long estrangement that had lessened only gradually, as they both grew older.

He read the email again, and before the morning faded, forwarded it to Tina George, his partner of 10 years, who lives in Arcata. That night they talked logistics: Reg wanted the whole family to gather beforehand in England, to celebrate his life -- and not to mourn. Dominic had no qualms about the suicide itself. He had long believed people have a right to die when and how they choose. So mostly, he and Tina talked about arranging the trip and whether she should come along.

The next morning, though, Dominic struggled for words to put into his email reply. What do you say to your own father when he announces his plans for passing? How do you sound supportive but not cold, or worse, eager? Dominic wrote, finally, that he didn't know quite what to say. To which Reg replied, "That is perfectly normal and understandable."

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Dominic Dawson had severed ties with his parents in 1968, moving out of the family home in London when he was 16 years old. He and his parents just didn't think the same way. He was embracing the freedom-loving ethos of the 1960s -- equal rights, anti-war, Eastern mysticism -- while his parents remained politically and socially conservative. He moved in with friends and took temporary jobs that were easy to find in London then: a clerk, a messenger, whatever kept him free from his parents' rules. After a couple of years he craved more adventure and traveled overland to India. He met and stayed with royalty in Bangladesh, and he lived for six months in Calcutta, working for an international relief organization. Then he bounced around some more -- traveling in the Middle East, then over to the United States, settling in the early 1970s in Santa Cruz, where he married and had his first daughter. In 1979, he arrived in Humboldt. To make it on the North Coast, he worked odd jobs and did lots of manual labor. He backpacked all over the Trinity Alps. He had a second daughter, in another relationship. Rooted in Humboldt, held by its natural beauty, Dominic has lived in the same Manila neighborhood since 1985.

The family ties with his parents reknit, but slowly. He would see them now and then, when they made trips to America. In 1996, the whole family gathered in England for his parents' 50th wedding anniversary. Not long after, he and his father began corresponding again. When the email about Switzerland came, Dominic was 60, with a 2-year-old grandson of his own. Gray-haired, blue-eyed and fit, he was semi-retired, running a delivery service, taking rafting trips with Tina. Now there was this -- and before it was over, both his parents would make fateful decisions.

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In California, as in many other states and many nations, helping or encouraging someone to commit suicide is a crime. The law stands even as public opinion has been shifting. In a 2006 Pew Research poll, 60 percent of those polled nationwide thought that people in great pain with no hope of improvement had a right to die. And 53 percent said people with an incurable disease had a right to choose death.

The idea appalls some advocates for the elderly and for people with disabilities. They worry about pressure from relatives who are crumbling under the stress of care, or who want to preserve family assets. Some religious groups, including the Roman Catholic Church, orthodox Judaism, and many evangelical Protestant denominations, consider suicide or helping with suicide a sin. Opponents warn that opening the door to legal assisted suicides could eventually lead to encouraging death for people deemed undesirable, people whose lives are looked at as somehow less worthy or less worthwhile than the lives of others. But amid those warnings, many religious, civil rights and patient rights groups champion the idea that people have a right to die, and that helping should be considered a kindness, not a crime. Legally assisted suicide, they say, gives people who have no hope of recovery the option to die before physical pain becomes unbearable or mental abilities are lost.

Worldwide, assisted suicide is legal in only a few places, including the Netherlands, Belgium, Luxembourg, Switzerland, Oregon and Washington, and the laws vary widely. Oregon and Washington have similar legislation, legalizing suicide under narrow conditions. A patient must be at least 18, a state resident and terminally diagnosed with six months or less to live. The patient must convince a doctor that he or she is of sound mind, making two oral requests and one written statement. Two doctors must sign separate forms verifying the patient's terminal illness. Then the state must approve the suicide, no sooner than 15 days after the first oral request. After all that, a physician can prescribe -- but not administer -- a lethal, swallow-able drug. No injections.

On the other end of the spectrum is Switzerland, with the most liberal suicide law in the world. Under article 115 of the Swiss Criminal Code, assisting another's suicide is criminal only if the motive is for personal gain. This sparse pronouncement was interpreted in the 1980s as a legal green light to create self-assisted suicide organizations. EXIT, founded in 1997, and Dignitas, founded in 1998, are among the best-known. Dignitas, which was featured in a 2012 Frontline documentary, is the only Swiss organization to accept foreigners. In the years since Dignitas' founding, the Swiss Supreme Court has expanded the law even more, ruling in 2006 that chronically depressed and mentally ill people have a right to assisted suicide. Today, Swiss law allows people with a range of non-terminal and progressive ailments to apply -- and if approved -- to choose to die.

Not all Swiss are on board with this right-to-die, death-with-dignity mission. In 2011, the Evangelical People's Party of Switzerland and the Swiss Federal Democratic Union lobbied heavily for a citywide referendum in Zurich over the practice. The May 2011 ballot measure asked residents whether assisted suicide should be banned altogether and whether organizations -- Dignitas specifically -- should admit foreigners. Despite heavy funding from Switzerland's conservative and religious right, the proposed ban was rejected by 84 percent of voters. And 78 percent voted to keep assisted suicide services available to overseas users.

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Dominic had always thought of his conservative parents as swift-witted and independent. Reg Dawson grew up in London and met his wife, then Betty Johnson, in the first years of World War II when they were both at a community dance. She was 15 and he was 17. Reg was getting ready for a stint in the Royal Air Force doing communications work. Theirs was a long courtship -- they didn't marry until after the war ended, in February of 1946. Their wedding picture shows him in uniform, his hair already thinning, one hand clasping Betty's. She is smiling a little more broadly, a white veil billowing behind her, sprays from a lavish bouquet trailing nearly to her knees. By then, both had converted to Catholicism. Dominic speculates the religion offered them a sense of spiritual security during the frightening years of wartime air raids.

Their oldest child, Teresa, was born in 1947. Soon after came Paul, then Dominic and Christopher. After the military, Reg worked as a negotiator in the British civil service. Once, Dominic recalls, Reg helped keep some commuter rail services alive by leaking information about government plans to stop them. Betty was a homemaker, focused on raising the children. She enjoyed cooking and baking and reading popular novels, her children remember. Once they were grown, she returned to school and became a business skills instructor, teaching typing and dictation. Over the years, both drifted from Catholicism -- Reg becoming an atheist and Betty an agnostic. Reg grew skeptical of organized religion and critical of government.

In the late 1980s, when Reg retired after more than 30 years in the civil service, he and his wife were still in good health, and Betty was a regular swimmer. That began to change with the turn of the new century. In 2002, Reg was diagnosed with Parkinson's, a degenerative disease. Their children noticed Betty's memory significantly slipping in 2006, although she wasn't officially diagnosed with Alzheimer's until 2012. Her early memories persisted -- childhood, early years of marriage, her children's youth -- but she was losing track of the day-to-day: luncheons, medical appointments. Had she turned off the stove, or was the water running in the bathroom? Reg first broached the subject of suicide with Teresa, a retired computer analyst who lives in Walnut Creek, when she was visiting her parents at her brother Christopher's house in London in the fall of 2010. "If your mother passes before I do," he directed in his calm British English, "I want to go to Switzerland and commit suicide." At the time, Teresa didn't think that her father would travel all the way to a Swiss clinic to end his life. "I wasn't worried," she recalled later. "I Skyped with them every week and was certain that when my father passed, it would be at their retirement community in Wales." Teresa and her three brothers assumed that Reg would die before their mother.

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As Reg's condition worsened, he became less and less willing to wait for his wife to pass away first. Even in October 2010, when he was 88 and she 86, she could no longer lift and move him. An attendant at their retirement community in Wales had to bathe him. And Betty had left a burner on. Again. Reg began emailing with his oldest son, Paul, about choosing suicide if he was unable to live and move independently. And Parkinson's disease does that, steals a person's independence. It's a nasty degenerative disorder of the central nervous system that begins with slight physical tremors, rigidity and difficulty walking, and then progresses to uncontrollable cognitive and behavioral problems. In late stages, dementia is common. Reg resisted using a wheelchair and insisted on walking as much as possible. By December 2011, though, he was resigned to a wheelchair most of the time, and by then, all four of his children knew he wanted to die. "When he announced his plan, my only surprise was how late he had left it," Paul remembered. "He was clearly not enjoying life at all." And Dominic, who at first had thought he would only attend his father's going away celebration in England, now reassured Teresa that he would go farther. If she wanted his help and support accompanying their father to Switzerland, Dominic would come along for that, too. Together, then, all four children planned how to best support Reg's choice, while making sure their mother would have a good quality of life after he was gone.

Betty, though, did not approve. Not for religious or philosophical reasons, but because for more than 60 years of marriage, they'd always been a team. Even as Reg's body withered, Betty had remained physically strong and able to help him. As she became more forgetful, Reg's mind remained razor sharp.

"But my mother also knew the reality of Alzheimer's," Teresa recalled, "My mother was afraid that if Reg went to Switzerland to die, that she would be alone and eventually die not knowing who her children are. This terrified her." And at least with Reg by her side, Betty had someone. Without him, she feared dying without memories or knowing who she was.

It wasn't so much that Betty didn't want Reg to go to Switzerland but that she didn't want him to go without her. Even with all four children ready to help, Reg hated the thought of leaving Betty alone. But he hated his continuing decline even more.

 

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In late October 2011, Reg paid $250 and joined the assisted suicide organization Dignitas, intent upon ending his life in Zurich, Switzerland, sometime in late 2012. The application process is not simple. There are thick packets of paperwork, and a Swiss physician must review the applicant's full medical records. To further complicate matters, assisted suicide is illegal in the United Kingdom, and doctors can lose their medical license and face up to 14 years in prison if caught knowingly releasing records for a suicide that would occur outside the country. But Reg wanted to do the right thing, be above board the whole way through. He was honest. At first. He told his doctors exactly what he was doing.

They curtly denied release of his medical records. 

A clever man, Reg changed tactics. A few weeks later, he re-contacted his physicians, this time telling them the records were needed for travel insurance to the United States for his 90th birthday celebration. It worked. He submitted his full application in December 2011. Now he had to wait, for Dignitas and for the approval of the Swiss government.

By then, in mid-December 2011, Reg's health was in a tailspin. Feeding himself had become prolonged and excruciating -- loss of muscle control meant that what food wasn't lost down his front was often smeared across his face. "My father was an extremely dignified man," Teresa said. "It was messy, but he preferred to feed himself." A meal could take an hour or more. And he had become incontinent.

Dominic, keeping in touch from afar, hated to think of his father hunched in a wheelchair, unable to go to the bathroom by himself. Reg's choice seemed courageous to his second son, and the obstacles he had to overcome were just one more sign of that courage.

As Reg worsened and Betty contemplated his hopes to die, she became uncharacteristically quiet and withdrawn. She cut short Skype sessions with her daughter and grandchildren, or skipped them entirely. This was not the vivacious business instructor and nurturing, reassuring mother Teresa had known. And then came the startling email from Reg. In January 2012, he wrote Teresa that Betty had read the Dignitas literature and wanted to die with him. Life would be intolerable without him, Betty felt, no matter how hard her children would try to help. She, too, would apply to Dignitas.

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By the end of January 2012, Reg Dawson received the provisional green light from Dignitas, which meant he had passed the Swiss medical review and could proceed with setting a date for his assisted suicide. The organization carefully advised him not to plan it on or near birthdays or other important family celebrations. At the same time, Betty began her application. They were hoping to die together.

To apply to Dignitas, a patient first must pay and become a member. Then comes the packet of paperwork and the required medical records, which can take up to three months to be evaluated. If the documents are approved, the patient must go to Zurich and meet with a physician, who will assess whether he or she is unpressured and of sound mind. Only then does Dignitas grant a provisional green light for the suicide. The week of the scheduled death, the patient must meet with two separate doctors to be sure this is what he or she wants to do.

Betty's application would be tricky. To comply with Swiss law, doctors affiliated with Dignitas would have to determine whether she was mentally sound enough to choose death. The question for doctors in such cases, according to a Dignitas pamphlet, is whether the decision is "a wish to die that is an expression of a curable psychic distortion and which calls for treatment" or a "self-determined, carefully considered and lasting decision of a lucid person." It is a difficult distinction for anyone, and was complicated by the Alzheimer's, which is considered a mental illness under Swiss law. Betty would have to convince doctors that she was capable of deciding to die.

And then, to make things even more difficult, she and Reg were applying for a double assisted suicide. The family was told that such suicides, with their more complex logistics, are relatively rare in Switzerland.

After three months of emailing between the Dawsons and Dignitas, a rewritten request letter from Betty, and more medical appointments in the United Kingdom and Zurich, Betty got the provisional green light in May of 2012. Now both of Dominic's parents had been cleared for assisted suicide, and they wanted to do it together. They needed two separate physicians for each of them to prescribe the lethal dosage. In August, Reg got word by email: the doctors had been arranged. After working around a large family's birthdays and wedding anniversaries, Reg and Betty set Sept. 17 as the day of their passing.

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Even the final arrangements would be complicated. Paul, an international finance professor, had professional obligations in Asia and couldn't be by their side. And the family feared that Christopher, a British citizen, could be detained and possibly arrested for involvement with their suicides once he returned to London. They all decided it was safer for him not to be in Switzerland. Teresa, Dominic and Tina -- all U.S. citizens -- seemed likely to face less, if any, scrutiny on their return to London from Zurich. It was agreed. The three of them would travel with Reg and Betty that final week.

With the suicide date set, Dominic and Tina flew to London during the first week of September. All of Reg and Betty's children, their nearest grandchild, and Reg's brother and wife also arrived. They talked and reflected quietly during the day. In the evenings the family dined together in London restaurants. On Sept. 11, Reg, Betty, Teresa, Dominic and Tina left London for Switzerland. There, they interspersed pre-suicide doctor visits with trips to Lake Thune and a visit to a pumpkin festival.

On Sept. 17, the five of them arrived at a Dignitas apartment in an industrial part of Zurich. The sun was bright and warm. A light breeze stirred the trees. Earlier that week, Reg and Betty had met with the physicians and had gotten their final approvals. Calm and relaxed, the family sat in the apartment, completing the last bits of paperwork. A Dignitas assistant brought Reg and Betty each cups of a liquid antiemetic to coat their stomachs so they wouldn't vomit on the lethal barbiturate dosage that would come later. Teresa and her mother left the apartment to sit beside a small pond outside and quietly enjoy the splendor of the warm afternoon. Reg, Dominic and Tina chatted for a bit and drank coffee for over an hour, long enough for the stomach coating to be fully effective. When the Betty and her daughter came back indoors, both parents were smiling.

"I think it's time," said Reg.

As required by Swiss law, a videotape was running. Reg and Betty Dawson were helped into a twin bed, where they nestled together. They had selected music for their passing. Liszt's Liebestraum No. 3 played softly, followed by Gluck's Orfeo ed Euridice. A dream of love, and then the underworld.

Reg joked about the luggage -- there will be more than necessary for the flight home. What will they do with the suitcases? The adult pads? "We won't need those anymore," he said. And Betty, smiling, piped up, "Oh, my jewelry." She slid off her engagement ring and wedding band, and lovingly extended them to Teresa.

The non-physician Dignitas assistant brought them each a cup of sodium pentobarbitol. These Reg and Betty had to drink very quickly, and they had to drink them unassisted. Reg sucked his through a straw. Betty slugged hers back without hesitation. When the cups were empty, the assistant gave them each a piece of Swiss chocolate to banish the bitter taste of the barbiturate cocktail.

The room was still. Betty leaned over and kissed Reg. Dominic held his father's free hand. Teresa held her mother's. The music continued softly in the background. Reg and Betty clasped hands and fell asleep slowly, peacefully. Finally.

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Dominic Dawson returned to his parents' home in Wales to put the last of their affairs to rest. Papers, books, family photos, CDs all sorted and organized by his hand. He listed their assisted living unit on the market. On Oct. 1, the family held a memorial service and Reg and Betty's ashes were scattered in the memorial garden of the British Railway Preservation Society, where they had been lifetime members.

Dominic, back home in Humboldt now, does not sorrow. From his cupola window, he can watch gulls soar. He can see a squadron of pelicans, flying in formation above the bay. "There's nothing to be sad about" he said. The way he looks at it, both his parents accomplished something worthwhile, and they both kept their dignity. "It was awe-inspiring. There was no fear or regret in those final days. I am thankful I was there."